INTRODUCTION In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed. METHODS Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression. RESULTS Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3-4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64). CONCLUSION While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

中文翻译：

---

早发慢性抑郁症患者长期轨迹的纵向聚类：广泛心理治疗后两年的自然随访。


引言 在临床试验中，主要分析重复横断面测量的群体水平治疗效果。然而，个体症状特征和治疗效果的变异性的显着异质性常常被忽视，特别是在长期过程中。为了提供有效的个性化治疗，迫切需要对这些特征进行研究。方法 采用心理治疗认知行为分析系统 (CBASP) 或支持性心理治疗 (SP) 进行为期一年的治疗后，对 104 周随访期间的抑郁严重程度评级进行了分析。进行纵向聚类分析和多项逻辑回归分析，以调查早发性慢性抑郁症最大的心理治疗试验之一的个体轨迹。结果 N = 188 名早发慢性抑郁症患者的两年研究后治疗轨迹被分为四个典型组。总体而言，16.0% 的患者病情缓解（组 1），并且大多数患者在 2 年随访期间未接受任何治疗。然而，84.0% 的患者继续出现阈值以下（37.2% 第 2 组）或重度抑郁症状（46.8% 第 3-4 组），并且平均一半以上的随访时间用于药物和心理治疗。层次回归分析表明，先前的研究治疗使用CBASP或SP并不能显着预测聚类分配，而基线变量占解释方差的很大一部分（R2 N = 0.64）。结论 虽然一些患者在 2 年的随访中经历了稳定的缓解，但大多数患者经历了阈下或重度抑郁症状，无论之前是否接受过 CBASP 或 SP 的研究治疗。 这需要从长远角度实施分期和创新治疗方法，例如序贯模型或模块化心理治疗。